Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up

Revisiting the universal femoral component: Midterm outcomes of a modern design

Introduction

Approximately 10 years ago a total knee arthroplasty system with a modern universal femoral component was introduced. It includes a symmetrical femoral and tibial component. The purpose of this study was to evaluate the 6-year clinical outcomes of this implant from a single surgeon.

Materials and methods

A retrospective chart review was performed on all patients who received a TJO Klassic® Knee from January 2014 to January 2015 (Total Joint Orthopedics Inc., Salt Lake City, Utah). In total there were 131 patients (149 knees) who underwent total knee arthroplasty with this system. A retrospective chart review was performed including demographics, preoperative and postoperative clinical assessments including Knee Society score (KSS), range of motion, and radiographic assessment.

Results

There were 60 males (45.8 %) and 71 females (54.2 %) with 149 knees available for review. Mean age at time of surgery was 67.4 years (45-91) and BMI was 32.6 kg/m2 (16.6-54.6). The patella was left unresurfaced in 37 knees (24.8 %), KSS scores including the clinical and functional components all improved significantly (p < 0.001). ROM improved significantly (p < 0.001). 9 knees underwent reoperation within 6 years of their index operation: 2 quadriceps tendon repairs, 3 polyethylene exchanges for laxity, 2 two-stage revisions for infection, 1 revision for aseptic loosening of the femur, and 1 for post-traumatic patella fracture.

Conclusion

6-year outcomes of a modern universal femoral design demonstrate excellent clinical results and survivorship equal to modern asymmetrical femur designs. There were no known instances of patellar maltracking.

Comparison of Cemented and Cementless Fixation in Total Knee Arthroplasty: A Meta-Analysis and Systematic Review of RCTs

OBJECTIVE

This study aimed to compare infection, aseptic loosening, revision, operation time, function scores, and the radiographic radiolucent line (RLL) between cementless and cemented fixation in total knee arthroplasty (TKA).

METHODS

Articles reporting the outcomes of cemented and cementless TKA were searched in Medline, EMBASE, Web of Science, and the Cochrane Library. The search was conducted from articles published from January 1996 to May 2024. Odds Ratios (OR) and confidence intervals (CI) were used to measure the results. Cochrane Collaboration's Review Manager software was used to perform the meta-analysis.

RESULTS

Sixteen randomized controlled trials containing 2358 participants were included in this meta-analysis. Pooled data found that, in TKA, there were no significant differences between cemented fixation and cementless fixation for a prosthesis in infection, aseptic loosening and revision. The subgroup analysis and sensitivity analysis results of the knee society score (KSS) showed a significant difference favoring cementless fixation in a follow-up of less than 5 years (MD = -2.30, 95%CI -3.85 -0.74, p = .001) while favoring cemented fixation in a follow-up over 5 years (MD = 2.79, 95%CI 0.95 4.63, p = .003). The operation time of cementless was less than that of cemented (MD = 12.03, 95%CI 8.30 15.77, p < .00001). No significant difference was detected in knee society function score, Western Ontario and McMaster Universities osteoarthritis index, and RLL. There was no heterogeneity across studies (p > .1), and most studies have a low risk of bias.

CONCLUSIONS

Within a follow-up period of less than 5 years, cementless TKA had better KSS, while over 5 years, KSS was better in cemented TKA, and cementless TKA required less operation time.

A Systematic Review and Network Meta-Analysis of the Outcomes of Patients With Total Knee Arthroplasty Using Cemented, Uncemented, or Hybrid Techniques

In this study, we aim to explore the differences among the three types of fixation methods for the components of the knee joint in patients who underwent total knee arthroplasty (TKA). These methods are cemented, uncemented, and hybrid fixation. Cemented fixation means that a special type of grout is used to attach the components to the bone. Uncemented fixation means that the components are designed to fit tightly into the bone and allow new bone growth to secure them. Hybrid fixation means that a combination of cemented and uncemented fixation is used for different components. We searched four online databases to find studies relevant to our research question. We use the R program (R Foundation for Statistical Computing, Vienna, Austria) for network meta-analysis (NMA) to analyze the data from the studies. We calculate the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between methods. We use these measures for continuous outcomes, meaning they can have any value. For dichotomous outcomes, meaning they can only have two values, we use the risk ratio (RR) and the 95% CI, which are statistical measures of the relative risk and the uncertainty between methods. We assess the quality of randomized controlled trials, which are studies that randomly assign participants to different methods, using the Cochrane Risk of Bias Assessment Tool 1, a tool that evaluates the potential biases in the studies. We include 21 studies, and our analysis shows that cemented TKA reveals a statistically significant decrease in pain with hybrid TKA (MD = -2.82). That said, we find no significant differences between uncemented and cemented or hybrid (MD = -0.80 and -2.02, respectively). The results show that there is no significant difference between uncemented TKA and cemented TKA or hybrid technique (RR = 0.87, 95% CI 0.35-2.14; RR = 0.73, 95% CI 0.22-2.39, respectively). Also, we find no significant difference between cemented TKA and hybrid TKA (RR = 0.84, 95% CI 0.24-2.93). Cemented TKA is associated with a lower risk of deep vein thrombosis (DVT) incidence rate. Moreover, it shows a significant decrease in pain compared to hybrid TKA. Future research is needed to compare among the three interventions.

Mechanical complications after total knee arthroplasty

INTRODUCTION

With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for patients, it is extremely important for surgeons to be able to anticipate and prevent TKA mechanical complications. Surgeons must be familiar with the different causes and mechanisms of TKA complications so that they can properly treat patients with failed TKAs and better avoid these complications.

AREAS COVERED

This review addresses TKA mechanical complications and provides context for the topic. A detailed review of surgical factors, implant factors, and patient factors that contribute to mechanical complications after TKA is provided. All of the literature cited in this review was gathered from the PubMed online database using different keywords based on the section of the manuscript.

EXPERT OPINION

As surgeons and engineers solve certain issues in TKA, new challenges will inevitably arise. We must continue to push forward and innovate from both a surgical technique and implant design perspective.

Cementless and Cemented Dual-pivot Total Knee Arthroplasty: A Matched Comparison with a Minimum Two-year Follow-up

INTRODUCTION

With the use of newer biomaterials, many authors have reported similar results between cementless and cemented total knee arthroplasty (TKA). The purpose of this study was to compare the early clinical and radiographic outcomes of cementless and cemented TKA using the same dual-pivot articulation.

METHODS

A consecutive series of 806 TKAs were implanted by a single surgeon using the same dual-pivot articulation. There were 634 TKAs (79%) cemented and 172 (21%) uncemented. One patient in the cementless group was lost before two years. The remaining 171 cementless TKAs were matched 1:1 with cemented TKAs with respect to age, sex, and body mass index (BMI). All patients were followed for a minimum of two years (range, 24 to 66 months) using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), and Knee Society clinical and radiographic evaluation. The average follow-up was 3.8 years (range, 24-66 months) in the cemented group and 3.4 years (range,24-56 months) in the cementless group.

RESULTS

At final follow-up, the average KOOS-JR score was higher in the cementless group (86 points (range, 64-100) vs. 80 points (range, 57-100). Post-op Knee Society scores (including pain and function) were similar. There was one deep infection (cemented TKA). The manipulation rate was 1.2% in the cementless group and 2.4% in the cemented TKA group. Excluding infection, two knees (1.2%) were revised in each group. No cases of femoral or tibial component loosening were identified.

CONCLUSION

Patients implanted with either a cemented or cementless TKA using the same conforming dual-pivot articulation design had similar early outcomes and functional improvements. The type of fixation did not appear to influence the early clinical results.

Is TKA femoral implant stability improved by pressure applied cement? a comparison of 2 cementing techniques

BACKGROUND

The majority of knee endoprostheses are cemented. In an earlier study the effects of different cementing techniques on cement penetration were evaluated using a Sawbone model. In this study we used a human cadaver model to study the effect of different cementing techniques on relative motion between the implant and the femoral shaft component under dynamic loading.

METHODS

Two different cementing techniques were tested in a group of 15 pairs of human fresh frozen legs. In one group a conventional cementation technique was used and, in another group, cementation was done using a pressurizing technique. Under dynamic loading that simulated real life conditions relative motion at the bone-implant interface were studied at 20 degrees and 50 degrees flexion.

RESULTS

In both scenarios, the relative motion anterior was significantly increased by pressure application. Distally, it was the same with higher loads. No significant difference could be measured posteriorly at 20°. At 50° flexion, however, pressurization reduced the posterior relative motion significantly at each load level.

CONCLUSION

The use of the pressurizer does not improve the overall fixation compared to an adequate manual cement application. The change depends on the loading, flexion angle and varies in its proportion in between the interface zones.

The influence of radiologic bone transparency after hybrid total knee arthroplasty on clinical outcomes: Minimum 6-year follow up of 214 cases

BACKGROUND

This study aimed to investigate how bone transparency affects loosening of the cementless femoral component by serially analyzing radiologic images in hybrid total knee arthroplasty (TKA).

METHODS

A total of 214 cases of TKA performed using the hybrid technique that were followed up for at least 6 years were retrospectively investigated. Bone transparency around the femoral component during the follow up period was evaluated. All TKA cases were divided into two groups and compared: those with radiologic bone transparency (bone transparency group, n = 51) and those without radiologic bone transparency (no bone transparency group, n = 163).

RESULTS

The incidence of revision TKA in all patients was 6.1%, and obesity, preoperative and postoperative mechanical alignment did not affect surgical outcomes. All bone transparency cases were asymptomatic, and only 8/51 cases (15.7%) of bone transparency spontaneously resolved. Between the bone transparency and no bone transparency groups, there was no difference found in the preoperative and postoperative radiologic parameters and clinical outcomes. During the follow up period, there were four (1.9%) cases with a definite radiolucent line in the femoral component, all of which belonged to the bone transparency group.

CONCLUSIONS

The bone transparency around the femoral component that appears on radiography after hybrid TKA could be an early sign of aseptic loosening; therefore, follow up serial radiography is essential.

Short-term results of the uncemented triathlon total knee arthroplasty: a large cohort single-centre comparative study

BACKGROUND

The purpose of this study is to assess the short-term survivorship of a new uncemented TKA design in a high-volume centre to evaluate the safety of this design prior to widespread adoption.

METHODS

We performed a retrospective cohort study of all primary TKAs (cemented and uncemented) between May 2018 and May 2019. Primary outcome variables included aseptic revision, all-cause revision, time to revision, operative time and radiological outcomes. Predictor variables considered included age, gender, BMI, ASA, implant type (cruciate-retaining, posterior-stabilised or totally-stabilised) and the use of cemented or uncemented implants.

RESULTS

There were 300 cemented TKAs and 249 uncemented TKAs (Triathlon, Stryker Inc., Mahwah, NJ) implanted. The mean follow-up for all cases was 31.6 months (minimum follow-up 2 years). Of the entire 549 implants only 4 were revised. Two of these were for infection, 1 was for patellar maltracking and 1 was for knee stiffness. All 4 revisions occurred in the cemented cohort. The aseptic revision rate in the cemented cohort was 0.7% compared to 0.0% in the uncemented cohort (p = 0.298). Operative times were significantly reduced in the uncemented cohort from 57.9 to 51.7 min (p < 0.001). There were 8/300 (2.6%) patients with RLLs in the cemented cohort and 4/249 (1.6%) patients with RLLs in the uncemented cohort (p = 0.56).

CONCLUSION

The uncemented Triathlon TKA demonstrates excellent survivorship at short-term follow-up when compared to the cemented Triathlon TKA, thus eliminating any potential clinical concerns with this novel implant in the early post-operative phase.

Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching

BACKGROUND

Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cemented versus cementless TKA.

METHODS

With PROs prospectively collected through Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.gov: NCT02810704), we examined pre- and post-operative (1, 3, and 6-months) outcomes in 5,961 patients undergoing primary TKA enrolled by 28 medical centers between December 2016 and August 2021. Outcomes included the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). To minimize selection bias, we performed a 1-to-1 propensity score matched analysis to assess relative pre- to post-operative change in outcomes within and between cemented and cementless TKA groups.

RESULTS

With greater than 90% follow-up, significant pre to- post-operative improvements were observed in both groups. At 6 months, the cemented TKA group achieved a 3.3 point (55% of the Minimum Clinically Important Difference) greater improvement in the mean KOOS-Jr. (95%CI: 0.36, 6.30; P = 0.028) than did the cementless group with no significant between-group differences in PROMIS-PH and NPRS.

CONCLUSIONS

In a large cohort of primary TKAs, patients with cemented fixation reported early incremental benefit in KOOS-Jr. over those with cementless TKA. Future studies are warranted to capture longer follow-up of PROs.

The mid-term survival of cemented, uncemented, and hybrid fixation of the ACS mobile bearing total knee arthroplasty

Background

Till today, Cemented Fixation in Total Knee Arthroplasty (TKA) is significantly more used than Hybrid or Uncemented Fixation. The purpose of this study was to compare Cemented, Uncemented and Hybrid Fixation of the ACS Mobile Bearing TKA at Mid-term follow-up.

Methods

This study was an extended data report of our prospective single-center, single-blinded randomized controlled clinical trial comprising 105 patients. The primary outcome was survival at five years of follow-up calculated by Kaplan-Meier and Log-rank test. The secondary outcome was function based on patient-reported outcome measures (PROMs).

Results

Eighty-three patients were included, of which 25 belonged into group A (Cemented), 28 in group B (Uncemented), and 30 in group C (Hybrid). Mean follow-up was 5.8 ± 0.7 (range 5-7) years. The 5-year survival rates were 96.8% (95%CI: 90.5; 100) in the Cemented group, 94.2% (95%CI: 86.4; 100) in the Uncemented group, and 93.8% (95%CI: 85.4; 100) in the Hybrid group for revision for any reason (p = 0.80). Functional outcome was similar among the groups.

Conclusion

In our cohort of ACS Mobile Bearing TKA, there was no difference between Cemented, Uncemented, and Hybrid Fixation with regard to survival and function at Mid-term follow-up.

Trial registration

Dutch Trial Register (NTR3893), 2013-03-12.

Level of evidence

II.

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study

PURPOSE

The purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA.

METHODS

A retrospective monocentric single surgeon case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta^®, Switzerland). Patient specific cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the final follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan-Meier model. Significance was set at p < 0.05.

RESULTS

Mean follow-up was 42.9 months ± 3.6 (range 37.6-46.7) and 53.3 months ± 4.1 (range 45.5-59.8) for rKA and MA groups. Postoperatively, no significant differences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip-Knee-Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a significant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint.

CONCLUSION

An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA.

LEVEL OF EVIDENCE

Retrospective case-control study, Level IV.

Press-Fit Dual-Pivot Total Knee Arthroplasty: Early Results With a Minimum 2-Year Follow-Up

BACKGROUND

Ultracongruent (UC) tibial bearings are being used with increasing frequency in the United States. Evidence suggests that the use of certain UC bearings may lead to improved patient satisfaction when compared with using conventional inserts. However, little is known as to what effect the use of UC tibial inserts has on bone ingrowth in uncemented total knee arthroplasty (TKA). The purpose of this study was to determine the early clinical and radiographic results of TKA using a press-fit dual-pivot design.

METHODS

Between 2017 and 2019, a consecutive series of 232 TKAs were implanted using a press-fit tibial and femoral component and a UC dual-pivot tibial insert. Sixty-two percent of patients were male. The average age was 56 years. Patients were followed for a minimum of 2 years (range, 24-42 months) using KOOS-JR and Knee Society clinical and radiographic evaluation.

RESULTS

No patient had more than mild knee stiffness at the final follow-up. Two patients reported moderate knee pain with stair climbing. All other patients reported either mild or no pain with activity. Knee Society pain scores averaged 42 points. Flexion averaged 118 degrees. Three knees (1.3%) were revised (one each for flexion instability, tibial plateau fracture, and suspected femoral component loosening). No other cases of femoral or tibial loosening were identified.

CONCLUSION

Although the success of uncemented TKA is determined by a variety of factors, the use of this dual-pivot knee design did not appear to influence tibial or femoral component fixation at early follow-up, yielding acceptable clinical and radiographic outcomes.

Long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15 years of follow-up

PURPOSE

To compare long-term clinical and radiographic results and survival rates between hybrid and cemented total knee arthroplasties (TKAs) performed on paired knees.

METHODS

Seventy-two patients with hybrid and cemented TKAs performed on paired knees with NexGen® cruciate-retaining prostheses were retrospectively reviewed after a minimum 15 years of follow-up. Mean follow-up period was 17.5 years. Preoperative alignment deformity and range of motion (ROM) were not different between groups. The Knee Society score, Western Ontario and McMaster Universities Osteoarthritis Index, and ROM were evaluated. Radiographically, change in joint space width, component loosening, and osteolysis were evaluated. Implant survival rate was analyzed.

RESULTS

There were no significant differences in clinical results between hybrid and cemented TKAs performed on paired knees of 72 patients at the last follow-up. No significant difference was observed in the change in joint space width between the two groups at the last follow-up (medial = 0.3 mm vs. 0.4 mm; lateral = 0.1 mm vs. 0.2 mm). One hybrid TKA showed tibial component loosening, for which revision was performed. There was femoral osteolysis in one hybrid and one cemented TKA, and tibial osteolysis in eight hybrid TKAs and seven cemented TKAs (n.s., respectively). The 20-year survival rate was 97.7% for hybrid TKAs and 100% for cemented TKAs (n.s.).

CONCLUSION

The long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15 years of follow-up. The method of femoral component fixation did not have a significant effect on long-term TKA success.

LEVEL OF EVIDENCE

III.

Long-term effects of cemented and cementless fixations of total knee arthroplasty: a meta-analysis and systematic review of randomized controlled trials

BACKGROUND

To determine the long-term effects (a minimum follow-up time 8.8 years) of cemented and cementless fixations used for total knee arthroplasty (TKA).

METHODS

PubMed, EMBASE, Ovid, Cochrane Library, CINAHL, China National Knowledge Infrastructure and China Wangfang database were interrogated for appropriate randomized controlled trials (RCTs) through July 2020. Data were extracted and assessed for accuracy by 2 of the authors acting independently. Any controversial discrepancies were resolved after discussion with a third author.

RESULT

Eight RCTs were included with low to moderate bias risks. The cemented fixation of TKA was comparable to cementless fixation in terms of implant survival (relative risk, 1.016; 95% CI 0.978 to 1.056; P = 0.417), Knee Society (KS) knee score (standardized mean difference (SMD), - 0.107; 95% CI - 0.259 to 0.045; P = 0.168), KS function score (SMD - 0.065; 95% CI - 0.238 to 0.109; P = 0.463), KS pain score (SMD - 0.300; 95% CI - 0.641 to 0.042; P = 0.085), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (SMD - 0.117; 95% CI - 0.307 to 0.073; P = 0.227), HSS score (SMD - 0.027; 95% CI - 0.270 to 0.217; P = 0.829), range of motion (SMD 0.061; 95% CI - 0.205 to 0.327; P = 0.652) at ≥ 8.8 years of follow-up. In terms of radiographic outcomes at ≥ 8.8 years of follow-up, the incidence of a radiolucent line in the cementless group was lower than for the cemented group (SMD 3.828; 95% CI 2.228 to 6.576; P < 0.001). However, the maximum total point motion (MTPM) of the cementless group was greater than for the cemented group (SMD - 0.739; 95% CI - 1.474 to - 0.005; P = 0.048).

CONCLUSIONS

Long-term follow-up verified that cementless and cemented fixation have similar prosthesis survival rates, clinical scores and mobility. However, radiography suggested that each technique had an advantage with regard to the radiolucent line and MTPM.

Risk of revision for medial unicompartmental knee arthroplasty according to fixation and bearing type : short- to mid-term results from the Dutch Arthroplasty Register

AIMS

Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs.

METHODS

A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed.

RESULTS

In hospitals performing less than 100 cases per year, cemented mobile bearings reported comparable adjusted risks of revision as uncemented mobile bearings. However, in hospitals performing more than 100 cases per year, the adjusted risk of revision was higher for cemented mobile bearings compared to uncemented mobile bearings (hazard ratio 1.78 (95% confidence interval 1.34 to 2.35)). The adjusted risk of revision between cemented fixed bearing and uncemented mobile bearing was comparable, independent of annual hospital volume. In addition, 12.3% of uncemented mobile bearing, 20.3% of cemented mobile bearing, and 41.5% of uncemented fixed bearing revisions were for tibial component loosening. The figures for instability were 23.6%, 14.5% and 11.7%, respectively, and for periprosthetic fractures were 10.0%, 2.8%, and 3.5%. Bearing exchange was the type of revision in 40% of uncemented mobile bearing, 24.3% of cemented mobile bearing, and 5.3% cemented fixed bearing revisions.

CONCLUSION

The findings of this study demonstrated improved survival with use of uncemented compared to cemented mobile bearings in medial UKA, only in those hospitals performing more than 100 cases per year. Cemented fixed bearings reported comparable survival results as uncemented mobile bearings, regardless of the annual hospital volume. The high rates of instability, periprosthetic fractures, and bearing exchange in uncemented mobile bearings emphasize the need for further research. Cite this article: Bone Joint J 2021;103-B(7):1261-1269.

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

Background and purpose - The increasing prevalence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) within the growing elderly population is translating into a larger number of patients with neuromuscular conditions such as myasthenia gravis (MG) receiving arthroplasty. We compared systemic and joint complications following a THA or TKA between patients with MG and patients without MG.Patients and methods - Patient records were queried from PearlDiver (Pearl Diver Inc, Fort Wayne, IN, USA), an administrative claims database, using ICD-9/ICD-10 and Current Procedural Terminology codes. In-hospital and 90-day post-discharge rates of systemic and joint complications were compared between the 2 cohorts.Results - 372 patients with MG and 249,428 patients without MG who received a THA or TKA were included in the study. At 90 days post-discharge, MG patients exhibited exhibited between 1.6 and 15% higher rates of systemic complications, including cerebrovascular event, pneumonia, respiratory failure, sepsis, myocardial infarction, acute renal failure, anemia, and deep vein thrombosis (all p < 0.001). The same results were also found during the in-hospital time period. 90-day incidence of aseptic loosening was the only joint complication with significantly increased odds risk for the MG cohort (OR 5; 95% CI 2-12).Interpretation - Patients with MG exhibited significantly higher risk for multiple systemic complications during the index hospital stay and in the acute post-discharge setting.